抑郁症患者究竟有多危险?

Ask Well: Jet Crash Raises Questions on Mental Illness Risks

抑郁症患者究竟有多危险?

The crash of the Germanwings jetliner has raised questions about mental illness and its consequences. Authorities have said that Andreas Lubitz, the co-pilot believed to have intentionally crashed the plane into the Alps, had a mental illness that he hid from the airline, that he was treated for “suicidal tendencies” before he got his pilot’s license, and that antidepressants were found in his apartment.

德国之翼(Germanwings)客机坠毁事件引发了公众对精神疾病及其影响的讨论。当局称，据信故意让客机坠毁在阿尔卑斯山的副驾驶安德烈亚斯·卢比茨(Andreas Lubitz)，向德国之翼隐瞒了他患有精神疾病的事实;早在拿到飞行员执照前，他就因有“自杀倾向”而接受过治疗;调查人员在他的公寓里发现了抗抑郁药。

Dr. Richard Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, will be responding to reader questions about mental illness and its risks.

韦尔·康奈尔医学院(Weill Cornell Medical College)临床精神病学教授理查德·弗里德曼(Richard Friedman)，将回应读者提出的与精神疾病及其风险有关的问题。

Q. Are most people who kill themselves depressed? What’s the relationship between suicide and depression?

问：大部分自杀者都患有抑郁症吗?自杀和抑郁症是什么关系?

A. We know from psychological autopsies that more than 90 percent of people who commit suicide have a diagnosable and potentially treatable psychiatric illness, most often depression — very often associated with alcohol or other drug abuse. Psychotic disorders like schizophrenia and schizoaffective disorder are also associated with an increased risk of suicide.

答：心理验尸研究表明，超过90%的自杀者被诊断为患有存在治愈可能的心理疾病，大多是抑郁症——常常涉及酗酒或者药物滥用。精神分裂症以及分裂情感性障碍等精神障碍，也会加大自杀的风险。

Q. Are antidepressant medications prescribed only for depression or also for other illnesses or conditions?

问：抗抑郁药物只能治疗抑郁症吗，还是说也可以治疗其他疾病?

A. Antidepressants are effective in the treatment of a wide range of psychiatric disorders, including depression and anxiety disorders like obsessive compulsive disorder, panic disorder and generalized anxiety disorder. They are also used in patients with certain personality disorders, such as borderline personality disorder, who may experience depressive symptoms

答：抗抑郁药物能有效治疗包括抑郁症和焦虑症在内的多种精神障碍，其中焦虑症又包括强迫症、恐慌症、泛焦虑症等。抗抑郁药物还被用于治疗患有某种人格障碍的患者，比如可能会出现抑郁症状的边缘性人格障碍患者。

Q. Are people who commit mass murder and suicide typically depressed? Is there a pattern of mental disorders associated with such rare acts?

问：谋杀多人者和自杀者通常都患有抑郁症吗?他们的罕见行为和精神障碍之间是否存在某种规律?

A. Mass murderers are typically young men who are loners, harbor a grudge and are very often psychotic. Those who commit murder-suicide are likely a different group of individuals. Murder-suicide is very rare, about 0.2 to 0.3/100,000 per year. Most of the perpetrators are men (40 to 50 years old), and the most common mental problem by psychological autopsy is depression. Those who commit murder-suicide typically kill people with whom they have been close (spouse, parent or child) and the motive is very often revenge.

答：谋杀多人者通常是独来独往、心怀怨恨的年轻男性，而且常常患有精神疾病。杀人后自杀者似乎应该被归入另外一个群体。杀人后自杀的行为非常罕见，每年的发生率在十万分之零点二到十万分之零点三之间。大部分施害者是男性(40至50岁)，通过心理验尸可以确定，抑郁症是他们最常患有的精神疾病。杀人后自杀者杀的通常是跟他们很亲近的人(配偶，父母或者孩子)，其动机通常是复仇。

Q. How common are suicidal thoughts and is it possible to predict who will actually commit suicide?

问：自杀的念头有多常见?有没有可能预测谁真的会自杀?

A. Suicidal thinking is probably fairly common in the general population and certainly much higher in people with psychiatric disorders like depression. While we know that there are clear risk factors for suicide — like having a mood disorder, being older or being male — most people with these characteristics do not go on to commit suicide, so our current ability to accurately predict suicide is low.

答：自杀的念头在一般人群中可能相当常见，在患有抑郁症等精神障碍的人群中则愈发常见。我们知道，患有情感障碍、年龄偏长或者性别为男等因素与自杀风险之间存在明显的关联，但大部分具有这些特征的人并不会自杀。因此，实际上很难预测谁会自杀。

Q. Are you concerned that this case and coverage of it is further stigmatizing people who suffer from depression?

问：你是否担心这件事及相关新闻报道会让抑郁症患者进一步被妖魔化。

A. I always worry about that. Horrifying outliers, like this case, create the false impression that psychiatric patients are dangerous, when we know the overwhelming amount of violence is perpetrated by normal people in the grip of normal human emotions. Still, there is no question that people with certain serious psychiatric illnesses are at a slightly higher risk of harming themselves and others compared with those without psychiatric illnesses, but the absolute risk is small.

答：我一直有这样的担忧。要知道，绝大多数暴力行为的实施者都是受控于正常人类情感的普通人，但可怕的极端案例——比如这件事——会让人错误地认为精神疾病患者很危险。毫无疑问，与没有精神疾病的人相比，患有某些严重精神疾病的人伤害自己或者他人的风险偏高一些，但绝对风险是很低的。

Q. Does depression ever really go away?

问：抑郁症真的能被治愈吗?

A. Depression is often a chronic illness characterized by relapses and recurrences, but it is also very treatable. Antidepressant medication and psychotherapy are effective not just in treating acute episodes of depression, but in preventing relapses as well.

答：抑郁症往往是慢性病，具有复发和再发的特点，但同时它绝对是可治疗的。抗抑郁药物和心理疗法不仅可以有效应对抑郁症的急性发作，而且可以防止抑郁症的复发。

Q. Do patients with bipolar disorder frequently attempt suicide?

问：双相障碍患者常常企图自杀?

A. Yes. Suicide risk in bipolar disorder is estimated to be about 0.4 percent per year, compared with a risk in the general population of about 0.014 percent per year. So the risk of suicide in people with bipolar disorder is roughly 25 times that of the general population.

答：是的。据估计，双相障碍患者每年自杀的概率为0.4%;相比之下，一般人的概率约为0.014%。因此，双相障碍患者的自杀风险约为一般人的25倍。